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April 11, 2011 -- Some hairstyles, including tight braids and weaves, may increase the risk of developing an irreversible form of scarring hair loss, according to a new study in the Archives of Dermatology.

Seen predominately in African-American women, this type of hair loss, central centrifugal cicatricial alopecia, centers on the vertex (crown) of the scalp and spreads peripherally.

“Any style that causes too much tension and traction on the hair, such as braiding with artificial hair weaved in, can possibly lead to scarring hair loss,” says study author Angela Kyei, MD, a dermatologist at the Cleveland Clinic in Cleveland, Ohio.

“You can’t bring the hair back, so you should see a dermatologist who specializes in hair loss and let them evaluate your scalp.”

In the study, 326 African-American women answered questionnaires about their hair-grooming methods, health status, and other demographic information. Dermatologists then performed a scalp examination to grade hair loss.

Nearly 60% of the women showed signs of advanced central hair loss with scarring. The women were also more likely to have type 2 diabetes and bacterial scalp infections, and sport hair styles associated with traction, including braids and weaves, the study showed.

The increase in type 2 diabetes among women with this form of hair loss dovetails with the theory that it may also be influenced by metabolic problems.

Hair Loss in African-American Women

“It is harder to manage tightly curled hair and is often not socially acceptable to wear hair in its natural form for these women,” Kyei says. So some women turn to braids and weaves, and because these hairstyles can be costly, they are sometimes worn for extended periods.

“But hair loss is permanent, meaning that we can inject steroids or creams but it won't bring your hair back, so it’s very important to seek help with dermatologists early on,” she says.

The study “is 100% true,” says Yael Halaas, MD, a facial plastic surgeon in New York City who specializes in hair restoration. “This type of hair loss starts from the center and spreads out," she says. “It is an epidemic among African-American women with a history of tight braids and weaves.”

Often the only treatment option is a hair transplant, she says. This can be problematic if the hair loss is extensive and has jeopardized donor sites.

“Avoid tight braids and weaves at all cost,” she says. “They will do damage.”

“Their hair has a lot of curl, which means it provides good coverage for thinning areas, so they are slower to take action because they don’t realize how much thinning they are getting,” Halaas says.

Neil Sadick, MD, a New York City-based dermatologist and clinical professor of dermatology at Weill Cornell Medical College, says this type of hair loss is a growing problem in women of color.

“These hair-grooming practices can lead to excessive trauma to the hair shaft of predisposed individuals [and] interfere with hair integrity and are major culprits in causing this cosmetically debilitating scarring hair loss,” he says.

“It can be best tempered by dermatologists by educating the patient to the deleterious effects of their current hair-styling practices and discontinuing excessive heat and chemical treatments to their hair,” he says.